1/23. Physical therapy after hand injuries.The nuances of physical therapy necessary in the trauma patient are discussed. This article also discusses either the treatment of fractures via therapy or the treatment of nerve, tendon, or arterial injuries. It also describes physical therapy guidelines relevant to the patient with hand trauma and reviews communication between the physician and therapist in managing these patients. Intervention concepts are illustrated through case studies of patients with complex hand injuries.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/23. Partial transient osteoporosis of the hand.OBJECTIVE: To describe the radiographic and scintigraphic findings of partial transient osteoporosis (PTO) of the hand. To discuss the relationship of PTO and other localized demineralizing diseases. DESIGN AND patients: Three patients with PTO that affected two or three digits of the hand are reported. Two patients were middle-aged women and the third was a young man. All presented with a history of trauma to the hand. All patients experienced localized burning pain, swelling and vasomotor changes including redness of the skin, hyperhidrosis and signs of vasomotor instability of the involved fingers. Plain radiography and bone scanning were used in the diagnosis and follow-up of these cases. RESULTS: All patients had a radial distribution of the osteoporosis that involved adjacent rays. In all patients two rays were involved. The radiographic changes manifested as minimal patchy osteoporosis involving the cortical, cancellous, subarticular and subperiosteal bone with no articular involvement. The increased uptake on scintigraphy coincided with the radial distribution of the osteoporosis. All patients improved on physical therapy and were symptom-free approximately 6 months after the initial injury. These patients were followed up for more than 2 years. CONCLUSION: PTO of the hand is an uncommon disease with typical clinical and radiographic findings. Bone scintigraphy confirms the partial involvement of the hand.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
3/23. work-related posttraumatic upper limb disorder. A case report.In this paper we describe a patient with mor-sensory loss in the right forearm and hand, which persisted more than 2 years after work-related crush trauma of the left hand. Radiographic and electromyographic investigations, somatosensory evoked potentials, CT scans of the encephalus as well as the minnesota Multiphasic personality inventory and the Roarschach test have been performed. On the basis of these investigations, we think this represents a case of conversion disorder with somatic features. Included is a brief overview of other psychological illness with physical findings involving the upper limb.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
4/23. Microsurgical reconstruction of the thermally injured upper extremity.The use of free flaps for coverage of the deeply burned hand has advantages that include the salvage of the exposed vessels, nerves, tendons, joints, and bone; a single operation to obtain wound closure, minimizing the risk of infection; and earlier physical therapy. This article focuses on the choice of suitable free flaps for the coverage of the deeply burned hand; and it also presents some case reports.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
5/23. Optimizing the correction of severe postburn hand deformities by using aggressive contracture releases and fasciocutaneous free-tissue transfers.Severe postburn hand deformities were classified into three major patterns: hyperextension deformity of the metacarpophalangeal joint of the fingers with dorsal contracture of the hand, adduction contracture of the thumb with hyperextension deformity of the interphalangeal joint, and flexion contracture of the palm. Over the past 6 years, 18 cases of severe postburn hand deformities were corrected with extensor tenotomy, joint capsulotomy, and release of volar plate and collateral ligament. The soft-tissue defects were reconstructed with various fasciocutaneous free flaps, including the arterialized venous flap (n = 4), dorsalis pedis flap (n = 3), posterior interosseous flap (n = 3), first web space free flap (n = 3), and radial forearm flap (n = 1). Early active physical therapy was applied. All flaps survived. Functional return of pinch and grip strength was possible in 16 cases. In 11 cases of reconstruction of the dorsum of the hand, the total active range of motion in all joints of the fingers averaged 140 degrees. The mean grip strength was 16.5 kg and key pinch was 3.5 kg. In palm reconstruction, the wider contact area facilitated the grasping of larger objects. In thumb reconstruction, key-pinch increased to 5.5 kg and the angle of the first web space increased to 45 degrees. Jebsen's hand function test was not possible before surgery; postoperatively, it showed more functional recovery in gross motion and in the dominant hand. Aggressive contracture release of the bone,joints, tendons, and soft tissue is required for optimal results in the correction of severe postburn hand deformities. Various fasciocutaneous free flaps used to reconstruct the defect provide early motion, appropriate thinness, and excellent cosmesis of the hand.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
6/23. Puncture wound during CPR from sternotomy wires: case report and discussion of periresuscitation infection risks.Performing resuscitations presents multiple infectious risks to critical care providers. Potential sources for infection include direct contact with blood and other bodily fluids and possible inoculation through needlestick injuries. In this article, we present a case of a cardiac care unit nurse who, while providing cardiopulmonary resuscitation, suffered a puncture wound to her left hand from the patient's sternotomy wires from previous cardiac surgery. The patient died despite these resuscitation efforts. He was seronegative for human immunodefiency virus, hepatitis b, and hepatitis c, and the nurse's wound healed without complications. This is the first reported case of such an injury occurring during a resuscitation. It demonstrates how a subtle, invisible, and unrecognized physical risk could cause infection in critical care providers.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
7/23. Pedicled groin flaps for upper-extremity reconstruction in the elderly: a report of 4 cases.The pedicled groin flap is a useful, versatile flap for coverage of wounds of the hand and distal forearm. It produces predictable results with a procedure that is much less difficult to perform and takes less time than a free-tissue transfer. Contrary to the general belief that the groin flap should not be used in the elderly because of the risk of shoulder stiffness, we found satisfactory results with this procedure in 4 elderly patients (age range, 59-75 y) when immediate shoulder mobilization was instituted and physical therapy was continued during flap maturation and pedicle division.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
8/23. A common origin for dental porcelain derived from an accused's hand and the decreased victim of an assault.A small, solid fragment removed from a wound on a hand of a murder suspect was submitted to electron microprobe analysis and found to have the properties of dental porcelain. A sample of porcelain removed from the dental bridge of the deceased had an essentially similar elemental profile. This investigation assisted the Court by providing valuable objective evidence of a physical contact between the accused and the victim.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
9/23. Electron paramagnetic resonance spectroscopic evidence of increased free radical generation and selective damage to skeletal muscle following lightning injury.The present case study examined changes in peripheral markers of free radical metabolism and skeletal/myocardial muscle damage 30 h after a mountaineer had survived a lightning storm, having experienced contact with what was considered to be "upward leaders" at 4200 m. Sea-level control data were available between 3 and 8 weeks prior to the altitude sojourn for comparative purposes. Follow-up measurements were obtained for the same individual 3 weeks following the incident after simulated exposure to the combined stresses of inspiratory hypoxia and physical exercise. Venous blood was assayed for molecular markers of skeletal [myoglobin and total creatine phosphokinase (CPK)] and myocardial [cardiac troponin i (cTnI)] muscle damage. Ex-vivo spin trapping with alpha-phenyl-tert-butylnitrone (PBN) combined with electron paramagnetic resonance (EPR) spectroscopy was incorporated for the direct detection of free radicals. The relative increases [post-exposure/preexposure x 100 (%)] in the concentration of the PBN adduct, myoglobin, and CPK in the "lightning blood" were markedly greater than those observed following the simulation study (PBN: 276 vs. 129%; CPK: 1130 vs. 182%; myoglobin: 205 vs. 115%). In contrast, no changes were observed for cTnI. A marked decrease in the PBN adduct, myoglobin, and CPK was observed within 2 h of completing the simulation study, following oral administration of water and lipid-soluble antioxidant vitamins in normoxia. These findings are the first to document lightning-induced free radical generation and selective damage to skeletal muscle in a high altitude mountaineer. Furthermore, free radicals may contribute to the pathogenesis of lightning injury, and dietary supplementation with antioxidant vitamins may prove of some benefit against associated tissue damage.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
10/23. Complex regional pain syndrome.A previously well fifty-five year-old female household helper developed complex regional pain syndrome Type II (reflex sympathetic dystrophy) following a minor injury to her left hand. She had marked hyperaesthesia and allodynia and was unable to perform her household work and to participate in the required physiotherapy. Following a series of stellate ganglion block, neurostimulation as well as physical therapy, there was a dramatic improvement in her condition and she was able to return to normal function.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
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